The Influence Of Dhakonan Traditional Games On The Level Of Dementia In The Selderly At Puskesmas Waru Kabupaten Sidoarjo Rista Fauziningtyas 1, Mita Nur Lathifah 2, Joni Hariyanto 3 Faculty of Nursing Universitas Airlangga Surabaya Email: rfauziningtyas@gmail.com ABSTRACT Introduction:The elderly problem is dementia, which can interfere daily activity. One of the treatment for elderly with dementia is reminiscence therapy with dhakonan traditional games. The purpose of this study is explain the effect of dhakonan traditional games on dementia level in the elderly. Methods:The design of this study was quasy-experiment design. The population was elderly with dementia in Desa Wedoro Kecamatan Waru Kabupaten Sidoarjo. The total sample were 20 respondents who appropriate to inclusion criteria. The sampling was simple random sampling. The independent variable was dhakonan traditional games, the dependent variable were cognitive function, depression, and dementia level. Data were collected using quissionaires of Mini Mental State Examination (MMSE), Geriatric Depression Scale (GDS), dan Functional Assessment Staging Tool (FAST). Data analysis were Wilcoxon Sign Rank Test and Mann Whitney Test with significance level of α<0,05 Results:Based on Wilcoxon Sign Rank Test found that p<0,05 for cognitive function, depression level, and dementia level in treatment group (cognitive function, p= 0,005; depression level, p= 0,005; dementia level, p= 0,014), it means the dhakonan traditional games had an effect to the dementia level in the elderly. Conclusion:The conclusions of this study was the dhakonan traditional games significantly increased cognitive function, decreased depression level and prevent progressifity of dementia level. The future studies can add the respondents and the specific factors that affecting intervention. Keyword: dhakonan, traditional games, elderly, cognitive function, depression, dementia would be changes in brain structure INTRODUCTION with age. This will result in cognitive The increase in the elderly and memory decline leading to population and will increase the number of digits in pain because of diseases caused by a degenerative process such as dementia (MoH-RI, dementia (Hand, 2013). Decline in cognitive function and memory not only affect everyday activities, but will also lead to changes in behavior 2013). In the study Riddle & and emotional control (Nugroho, Schindler (2007) in Kuczynski (2009) 2008). Dementia can be treated with states that although there is a multiple therapies one of which neurodegenerative disease, still there memories with cognitive stimulation
therapy to improve cognitive function of patients (Orell et al, 2008). Cognitive stimulation can be therapeutic activity of one of them is a game dhakonan. Dhakonan game will stimulate motor, cognitive, and emotional at the same time so that it will train the intellectual intelligence and emotional intelligence of a person (Alert, 2014). Until now the game dhakonan influence on cognitive function and emotional / mood in efforts to prevent the development of dementia further levels still need to be clarified. Data Alzheimer's Disease International (ADI) in 2015 showed people with dementia in the world reaching more than 46.8 million people. It is estimated that the number of people with dementia will increase to reach 131.5 million by 2050. The elderly population in Asia in 2015 reached 485 million people and dementia as many as 22 million people. This number will increase to 38 million in 2030 and increased again to 67 million in 2050. Currently, Indonesia is among the top five countries with the largest number of senior citizens in the world. The population census in 2010 put the number of elderly people in Indonesia reached 18.1 million people (7.6%). In 2014 the number of elderly continue to rise to 18.78 million. Bappenas assessing in 2025 Indonesia has the highest number of elderly globally ie around 36 million people and by 2050 to 80 million. According to the World Alzheimer's Reports (2015), Indonesia is among the top ten countries in the world which has the highest rate of people with dementia that some 1.2 million people. When viewed from distribution in Indonesia, the province with the elderly most nation points in 2015 was the province of DI Yogyakarta (13.4%), Central Java (11.8%), East Java (11.5%) and Bali (10.3% ). The number of elderly in East Java reached 11.5%, which is about 4.2 million (Central Bureau of Statistics, 2015). Some areas which have the most elderly in East Java, one of which is Sidoarjo. According to data from the District Health Office Sidoarjo 2015 elderly people in Sidoarjo as many as 131 517 people, districts that have a number of elderly most was the District Waru namely 8453 inhabitants and villages with the number of elderly is the highest village Wedoro that is 517 people, but there is no clear data on the number of elderly dementia. According Lautenschlager (2008), the more the number of elderly people, the more the likelihood that dementia incidence with age is a risk factor for dementia. In the initial survey date of March 5, 2016 at the IHC Wdoro known that traditional games are often played by the elderly as a young man is dhakonan. Researchers conducted a second survey on 25 to 29 April 2016 for the village of the District Wedoro Waru Sidoarjo. In a survey conducted in 25 elderly people, there are 18 elderly who have cognitive impairment. Researchers conducted a survey using the clock drawing test and got one person to get a score of 0, 2 people get a score
of 1, 10 people got a score of 2, and 5 people got a score 3. Score normal on clock drawing test is> 4, if the score <4 showed impaired cognitive. Problems faced by elderly people with dementia include changes in cognitive function, behavior, decreased physical activity, mental, social function and decreased quality of life (Huang, 2015). Changes in prefrontal part of the brain will affect the cognitive, and changes in the hippocampus affects memory storage (Drag, 2010; PERDOSSI 2008 in Hidayati, 2013). The decline of cognitive function in elderly people with dementia causing forgetfulness is not even able to retain new information is received. Impaired memory can lead to decreased ability to remember the time, recognize people, objects, and places. Not only that, dementia also causes behavioral disorders such as suspicious, stubborn, irritable, become depressed and crying for no apparent reason and can not perform activities of daily living independently so that the quality of life of the elderly be decreased (Maryam, 2008). One therapy used to elderly dementia is Reminiscence therapy. According to Hurlock (1987) in Sa'adah (2013), playing is an activity for pleasure and satisfaction. Therapy can be done using the game because it reminds the elderly in a pleasant childhood memory. According to Vygotsky (1976) in Musfiroh (2008), has played an important role in the development of cognitive and emotional. Games that can be done one of them isdhakonan. This game can train the brain to create strategies, improve intelligence, exercise patience and honesty (Rismawati, 2012). Not only that, dhakonan also useful to practice concentration, decision-making, numeracy and analyzes that will increase a person's cognitive function (Donkers, 2002). It can slow down the damage to the memory in people with dementia so it can reduce the development of dementia to the next level. This study aims to determine the effect dhakonan game against the rate of dementia in the elderly. METHODS This study has received a certificate of conduct worthy of Airlangga University Faculty of Nursing Ethics Committee. Research conducted an experiment whose design quasy control group pre postttest design (Clamp, Gough, & Land, 2004). Researchers divided the sample into two groups: the control group and the treatment group. The treatment group was given another intervention by dhakonan game, while the control group was given no intervention dhakonan game. The population is determined by using the inclusion criteria: (1) the elderly aged 60-74 years who are prademensia, mild dementia, moderate dementia or dementia were severe; (2) Elderly Clock Drawing Test with a score of <4 at the time of screening; (3) Elderly youth who never played dhakonan: (4) Elderly living with a family, exclusion criteria were used: (1) elderly with impaired vision and hearing heavy.; (2) Elderly who have
a history of stroke, Parkinson's, diabetes mellitus, tumors of the brain or head trauma; (3) Elderly who are mentally handicapped. The samples using simple random sampling. The sample size is set at 10 elderly on each kelompok.permaianandhakonan done 2 times a week for 3 weeks. The RESULT duration of each game is 60 minutes. Pre and post test is done by using the instrument Mini-Mental State Exam (MMSE) and the Functional Assessment Staging Test (FAST). Results were analyzed using the Mann Whitney Test with a significant level of α 0.05, 1. Pre and post tes cognitive function results in control and treatment group Table 1 Pre and post tes cognitive function results in control and treatment group Control Group Treatment Group Pre Test Post test Pre Test Post test f (x) % f (x) % f (x) % f (x) % Normal 0 0 0 0 0 0 3 30 Mild Cognitive 7 70 4 40 5 50 7 70 Disorder Moderate 3 30 6 60 5 50 0 0 Cognitive Disorder Severe 0 0 0 0 0 0 0 0 Cognitive Disorder 10 100 10 100 10 100 10 100 Wilcoxon Signed Rank p = 0,183 α = 0,05 p = 0,005 α = 0,05 Test Mann Whitney Test pre treatment p = 0,704 α = 0,05 Mann Whitney Test post treatment p = 0,002 α = 0,05 test results is cognitive disorders Table 1 shows the results of Wilcoxon Signed Rank Test and Mann Whitney being some 60%. In the control group the results obtained so p = 0.183 p> Test cognitive function in both 0.05, which means there is no groups. Wilcoxon Signed Rank Test was used to test for differences in the results of pre-test and post test. The results of the pre-test control group difference between the pre-test and post-test. The results of the pre-test treatment group was mild cognitive impairment by 50% and moderate the majority are mild cognitive cognitive impairment by 50%, while impairment by 70%, while the post- the majority of post test results is
mild cognitive impairment, 60% and become normal as much as 30%. In the treatment group results Wilcoxon Signed Rank Test thus obtained p = 0.005 p <0.05. This shows that there are significant differences between the pre-test and post-test. In the pre test the control and treatment of test results obtained Mann Whitney Test p = 0.704, which means there is no difference between the two groups, whereas in the post test showed p = 0.002, which means there is a significant difference between the control group and the treatment group. It can be concluded that there is an influence on the function of traditional games dhakonan to cognitive elderly. 2. Pre and post test dementia level in control and treatment group Tabel 2. Results of Pre and post test dementia level in control and treatment group Control Group Treatment Group Pre Test Post test Pre Test Post test f (x) % f (x) % f (x) % f (x) % Stadium 1 0 0 0 0 0 C 3 30 Stadium 2 0 0 0 0 0 0 1 10 Stadium 3 7 70 4 40 5 50 9 90 Stadium 4 2 20 4 40 5 50 0 0 Stadium 5 1 10 2 20 0 0 0 0 Stadium 6 0 0 0 0 0 0 0 0 Stadium 7 0 0 0 0 0 0 0 0 10 100 10 100 10 100 10 100 Wilcoxon Signed Rank Test p = 0,157 α = 0,05 Mann Whitney Test pre treatment p = 0,579 α = 0,05 Mann Whitney Test post treatment p = 0,004 α = 0,05 p = 0,0014 α = 0,05
Table 2 shows that the rate of dementia in the pre test most of the control group was stage 3 by 70%, 20% stage 4 and stage 5 of 10%. In the post test results rate of dementia is stage 3 as much as 40%, 40% stage 4 and stage 5 an amount of 20%. Results Wilcoxon Signed Rank Test in the control group was obtained p = 0,157 which means there is no difference between the pre-test and post test. In the treatment group pre-test results showed respondents have a degree of dementia by 50% stage 3 and stage 4 some 50%. In the post test results obtained rates of dementia as much as 90% stage 3 and stage 2 by 10%. Results Wilcoxon Signed Rank Test in the treatment group was obtained p = 0.014, which means there is a difference between the pre-test and post-test. In the pre test the control and treatment of test results obtained Mann Whitney Test p = 0,579 which means there is no difference between the two groups, whereas in the post test showed p = 0.004, which means there is a significant difference between the control group and the treatment group. It can be concluded that there are significant levels of traditional games dhakonan against dementia level DISCUSSION In the treatment group there were significant differences on cognitive function before and after the traditional game dhakonan. Before the game dhakonan intervention, cognitive function of respondents classified as mild cognitive impairment and cognitive impairment was, after the intervention of respondents cognitive function improved to normal and mild cognitive impairment. At a data rate of depression treatment group also found a significant difference between the results before and after the intervention. Before the intervention given the depressed levels in the treatment group was mild depression and no depression or normal. When the respondents have done dhakonan game, all respondents decreased to normal levels of depression or no depression. Data rates of dementia before the intervention of respondents obtained dhakonan game developed dementia early stage 3 or stage 4 or dementia and mild dementia with the same percentage. Statistical analysis showed that the difference in rates of dementia before and after the intervention in the experimental group there are significant differences. In the majority of respondents after the intervention given the level of dementia becomes stage 3 and and there is one respondent dementia stage 2 6 INTERNATIONAL NURSING WORKSHOP AND CONFERENCE Professional Nursing Practice In Free Trade Era: Threat & Challenge Surabaya, December 6 th -8 th, 2016
or Subjective Cognitive Impairment. The results of this study indicate that after the game dhakonan cognitive function of elderly be increased so there is no increase in rates of dementia to more severe levels, in other words the game dhakonan could prevent the progression of dementia. Research Huang (2015) proved that some previous research on reminiscence therapy is effective for improving cognitive and reduce depression in the elderly with dementia. Cotelli study (2012) showed that reminiscence therapy can improve cognitive ability, mood and improved behavior in patients with dementia. According to the Gold (1998) in Banon (2011), memories therapy aims to provide an opportunity to socialize, diversion, pleasure, communication, reduce depression and social isolation and increase self-esteem and life satisfaction of elderly based on self-assessment and achievements. Therapy memorable effect on cognitive, psychological, social habits and the level of health of the elderly (Hsieh & Wang, 2003). Not only that, the memories will also improve self-esteem and life satisfaction of elderly, improving the ability to adapt to stress through ability in problem solving and improvement in social relationships with others (Banon, 2013). This therapy will maximize its potential and provide a positive value in the elderly. According to Latif (2000), memories of therapy will give an impulse to the memory. Memory is a process of sensory impulses that will be used in future as a regulator of motor activity and thinking process. Memory storage occurs mostly in the cerebral cortex that has more than 10 billion brain cells and is associated with other cells. One brain cell has a relationship with another brain cell 4000-10000 through conductive substance or the excitatory neurotransmitter is a chemical and electrical impulses in the body. Information storage is also the role of the synapse, so any sensory signal synapse passing lane will in future be able to distribute the same signal, the signal delivery process called facilitation. If the synapse is often traversed by sensory signals it will be facilitated, and the signal arising from the brain is able to channel the impulse through the synapse same although there is no sensory impulses. Synapse facilities such activity will affect the subconscious thought processes (sub conscious mind) giving rise to the perception of the experience the real sensation and the body may respond although the effect is only a memory of a sensation. If the memory is stored in the nervous system, then the memory will be part of the 7 INTERNATIONAL NURSING WORKSHOP AND CONFERENCE Professional Nursing Practice In Free Trade Era: Threat & Challenge Surabaya, December 6 th -8 th, 2016
mechanism of processing and into the human memory system. One part of the brain involved in memory store is hippoccampus. Hippoccampus can move information from short-term memory into long-term memory is a relatively permanent information storage (Lahey, 2007; Santrock, 2005). Dhakonan game will evoke memories of past pleasant elderly and can stimulate the brain to think, practice concentration, create strategies, and analyze. Stimulation of the game dhakonan responded by sight (visual) and movement (kinesthetic). In the visual, light seen by the eye forwarded by the lens and the retina is accepted, then those signals through the optic nerve to the optic chiasm (optic chiasm) and then through the optic tract to enter the brain. In kinesthetic afferent sensory neuron function to deliver information from the receptors leading to spinal corda then through parabrachial complex (PBC) and periaquaductal gray (PAG) to the brain. Both of these responses will be heading to the cerebral cortex and the limbic system in which there are the amygdala, which acts to regulate emotion and memory, as well as the hippocampus are involved in memory storage. While playing dhakonan, the hippocampus and the amygdala occur episodic memory retrieval process to dig the memory that has been stored in the brain. In the next stage of impulses transmitted to the prefrontal and influenced by the spiritual node that will induce a feeling happy and comfortable when the memories contained in the hippocampus and amygdala are positive. Impulses into the prefrontal will stimulate the prefrontal to work according to its function such as planning, organizing, and problem solving. CONCLUSION Intervention dhakonan traditional games can improve cognitive function of elderly through exercise analyzes, strategic thinking, counting, fine motor and train the elderly. In the traditional game dhakonan can decrease levels of depression to be normal social interaction with friends to play and can recall the good old days. Effects of traditional games dhakonan can maintain the level of dementia or prevent the progression of dementia because it is effective for improving cognitive function. Nurses can provide additional knowledge to the elderly how to prevent the development of dementia levels and help the elderly to intervene dhakonan traditional game involving the family. Researchers can then add the number of samples and special factors affecting the intervention. The use 8 INTERNATIONAL NURSING WORKSHOP AND CONFERENCE Professional Nursing Practice In Free Trade Era: Threat & Challenge Surabaya, December 6 th -8 th, 2016
of other instruments as a measuring tool may also be considered. REFERENCES Asosiasi Alzheimer Indonesia 2003, Konsensus Nasional Pengenalan dan Penatalaksanaan Demensia Alzheimer dan Demensia Lainnya, edisi 1, Asosiasi Alzheimer Indonesia, Jakarta. Badan Pusat Statistik 2015, Kebutuhan dan Ketenagakerjaan untuk Pembangunan Berkelanjutan, BPS, Jakarta. Banon, Endang 2011, 'Pengaruh Terapi Reminiscence dan Psikoedukasi Keluarga Terhadap Kondisi Depresi dan Kualitas Hidup Lansia di Katulampa Bogor', Tesis, Universitas Indonesia, Depok Donkers, Uiterwijk, & Voogt 2002, 'Mancala Games topics in Artificial Intellegence and Mathematics. Step by Step. Proceeding of the 4th Colloquium', Board Games in Academia, Universitaries Fribourg, Switserland Huang, HC, Chen, Hu, Liu, Kuo, & Chiu 2015, 'Reminiscence Therapy Improves Cognitive Functions and Reduces Depressive Symptoms in Elderly People With Dementia: A Meta-Analysis of Randomized Controlled Trials', Journal of the American Medical Directors Association, vol. 12, hal. 1087-1094. KEMENKES RI 2013, Buletin Jendela Data dan Informasi Kesehatan, KEMENKES RI, Jakarta Kuczynski, B, Jagust, W, Chui, HC, & Reed, B 2009, 'An Inverse Association of Cardiovascular Risk and Frontal Lobe Glucose Metabolism', Neurology, vol. 72, no.8, hal. 738 743. Lahey,BB 2007, Psychology An Introduction. Ninth Edition, McGraw-Hill, New York. Latif, V 2000, Cara Memori Bekerja, diakses 17 Mei 2016, http://google.co.id/seacrh? hl=1d&q=fisiologi+memori &meta Nugroho, W 2008, Keperawatan Gerontik dan Geriatri, EGC, Jakarta. Maryam, Siti. (2008). Mengenal Usia Lanjut dan Perawatannya. Jakarta: Salemba Medika 9 INTERNATIONAL NURSING WORKSHOP AND CONFERENCE Professional Nursing Practice In Free Trade Era: Threat & Challenge Surabaya, December 6 th -8 th, 2016
Santrock, JW 2005, Perkembangan Masa Hidup, Erlangga, Jakarta. 10 INTERNATIONAL NURSING WORKSHOP AND CONFERENCE Professional Nursing Practice In Free Trade Era: Threat & Challenge Surabaya, December 6 th -8 th, 2016